Un-constraining the constraints of AACs (communication boards)

The humor of this joke sheds light on the irony of trying to constrain communication:
The joke-teller's convention in the Catskills

Vidatak's syntax http://www.acuitymedical.com/ecommerce/www-vidatak-com-1.html

dialysis and communication disorders
Communicating understanding and desires for end-of-life issues (presentation with sample boards) Richard Hurtig CAAC Research Conference September 2012

http://www.aacfundinghelp.com/funding_programs/medicare.html
http://www.asha.org/practice/reimbursement/medicare/sgd_policy/
http://www.asha.org/SLP/healthcare/Medicare-Speech-Generating-Devices-Information/

A speech-generating device (E2500 - E2511) is covered when all of the following criteria (1-7) are met. If one or more of the SGD coverage criteria 1-7 is not met, the SGD will be denied as not medically necessary.

1. Prior to the delivery of the SGD, the patient has had a formal evaluation of their cognitive and communication abilities by a speech-language pathologist (SLP). The formal, written evaluation must include, at a minimum, the following elements:
   • current communication impairment, including the type, severity, language skills, cognitive ability, and anticipated course of the impairment
   • an assessment of whether the individual's daily communication needs could be met using other natural modes of communication
   • a description of the functional communication goals expected to be achieved and treatment options
   • rationale for selection of a specific device and any accessories
   • demonstration that the patient possesses a treatment plan that includes a training schedule for the selected device
   • the cognitive and physical abilities to effectively use the selected device and any accessories to communicate
   • for a subsequent upgrade to a previously issued SGD, information regarding the functional benefit to the patient of the upgrade compared to the initially provided SGD
2. The patient's medical condition is one resulting in a severe expressive speech impairment
3. The patient's speaking needs cannot be met using natural communication methods
4. Other forms of treatment have been considered and ruled out
5. The patient's speech impairment will benefit from the device ordered
6. A copy of the SLP's written evaluation and recommendation has been forwarded to the patient's treating physician prior to ordering the device
7. The SLP performing the patient evaluation may not be an employee of or have a financial relationship with the supplier of the SGD

Codes E2500 - E2510 and code E2511 perform the same essential function-speech generation. Therefore, claims for more than one SGD will be denied as not medically necessary. Laptop computers, desktop computers, PDAs, or other devices that are not dedicated SGDs are not covered because they do not meet the definition of durable medical equipment (DME). Software (E2511) that enables a laptop computer, desktop computer, or PDA to function as an SGD is covered as an SGD; however, installation of the program or technical support are not separately reimbursable.